A randomized controlled trial of an internal family systems-based psychotherapeutic intervention on outcomes in rheumatoid arthritis: a proof-of-concept study
Nancy A Shadick, Nancy F Sowell, Michelle L Frits, Suzanne M Hoffman, Shelley A Hartz, Fran D Booth, Martha Sweezy, Patricia R Rogers, Rina L Dubin, Joan C Atkinson, Amy L Friedman, Fernando Augusto, Christine K Iannaccone, Anne H Fossel, Gillian Quinn, Jing Cui, Elena Losina, Richard C Schwartz, Nancy A Shadick, Nancy F Sowell, Michelle L Frits, Suzanne M Hoffman, Shelley A Hartz, Fran D Booth, Martha Sweezy, Patricia R Rogers, Rina L Dubin, Joan C Atkinson, Amy L Friedman, Fernando Augusto, Christine K Iannaccone, Anne H Fossel, Gillian Quinn, Jing Cui, Elena Losina, Richard C Schwartz
Abstract
Objective: To conduct a proof-of-concept randomized trial of an Internal Family Systems (IFS) psychotherapeutic intervention on rheumatoid arthritis (RA) disease activity and psychological status.
Methods: Patients with RA were randomized to either an IFS group for 9 months (n = 39) or an education (control) group (n = 40) that received mailed materials on RA symptoms and management. The groups were evaluated every 3 months until intervention end and 1 year later. Self-assessed joint pain (RA Disease Activity Index joint score), Short Form-12 physical function score, visual analog scale for overall pain and mental health status (Beck Depression Inventory, and State Trait Anxiety Inventory) were assessed. The 28-joint Disease Activity Score-C-reactive Protein 4 was determined by rheumatologists blinded to group assignment. Treatment effects were estimated by between-group differences, and mixed model repeated measures compared trends between study arms at 9 months and 1 year after intervention end.
Results: Of 79 participants randomized, 68 completed the study assessments and 82% of the IFS group completed the protocol. Posttreatment improvements favoring the IFS group occurred in overall pain [mean treatment effects -14.9 (29.1 SD); p = 0.04], and physical function [14.6 (25.3); p = 0.04]. Posttreatment improvements were sustained 1 year later in self-assessed joint pain [-0.6 (1.1); p = 0.04], self-compassion [1.8 (2.8); p = 0.01], and depressive symptoms [-3.2 (5.0); p =0.01]. There were no sustained improvements in anxiety, self-efficacy, or disease activity.
Conclusion: An IFS-based intervention is feasible and acceptable to patients with RA and may complement medical management of the disease. Future efficacy trials are warranted. ClinicalTrials.gov identifier: NCT00869349.
Keywords: BEHAVIORAL MEDICINE; CLINICAL TRIALS; DEPRESSION; DISEASE ACTIVITY; PSYCHOTHERAPY; RHEUMATOID ARTHRITIS.
Source: PubMed